Glenoid arthroplasty

ABSTRACT

Arthroplasty components include an articular surface and a bone-facing surface. The bone-facing surface bears at least one anchoring element adapted for an oblique implantation trajectory. The articular surface may include a larger radius of curvature in the superior-inferior direction than in the anterior-posterior direction. An inferior chamfer may be present on the articular surface. Instruments and implantation methods are also disclosed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of:

U.S. patent application Ser. No. 14/042,258, filed Sep. 30, 2013,entitled GLENOID ARTHROPLASTY, Attorney's docket no. CAO-1, which ispending.

U.S. patent application Ser. No. 14/042,258 claims the benefit of:

U.S. Provisional Patent Application No. 61/776,398, filed Mar. 11, 2013,entitled OBLIQUE INSERTION ANCHORING MECHANISM FOR SHOULDER PROSTHETICCOMPONENT, Attorney's docket no. McHale/Slavin 3858U.001, which isexpired.

The above-identified documents are incorporated herein by reference intheir entirety.

BACKGROUND

The present disclosure relates to anchoring elements and articularsurfaces for human or veterinary implants. The disclosed anchoringelements are useful in situations where exposure is difficult, theimplantation trajectory is oblique to the implantation site, or theimplantation site is tapered, conical, or wedge-shaped. For example, thedisclosed anchoring elements are useful in the context of a glenoidimplant for shoulder arthroplasty, so that the preparation of theglenoid and implantation of the glenoid component take place along anoblique surgical access and implantation trajectory. An obliqueapproach, or an antero-lateral approach, to the glenoid is technicallysimpler and less invasive than a lateral trajectory to the glenoid. Thisdisclosure is made in the context of a glenoid component for shoulderarthroplasty for the purpose of illustrating the relevant principles ofthe technology.

In total shoulder arthroplasty, a glenoid implant is attached to aprepared glenoid or scapula, and a humeral implant is attached to aprepared humerus. The humeral implant usually includes a ball or convexarticular surface at a proximal end thereof which engages and movesrelative to a socket or concave articular surface formed in a lateralaspect of the glenoid implant, although this arrangement is sometimesreversed so that the humeral implant includes the convex articularsurface and the glenoid implant includes the convex articular surface.The ligaments and muscles of the shoulder surround the implants andmaintain the humeral implant against the glenoid implant, while at thesame time allowing relative movement therebetween.

Current implants frequently have a central peg or keel, occasionallywith two or three small peripheral supporting pegs. These implants relyon the centrally placed anchoring element to provide the majority of thefixation. In situations where the surgeon encounters bone defects, bonecysts, or where a prior component has been removed, there is often acentral defect in the bone where fixation is not possible.

Current instruments for standard glenoid arthroplasty, including drillbits, reamers, and trial implant components, and final implantcomponents are frequently designed for the surgeon to approach thescapula along a direction perpendicular to the face of the glenoidportion of the scapula; this may be referred to as a direct lateraltrajectory. However, the standard incisions and safest surgical approachfor glenoid arthroplasty provide exposure for the surgeon which is moreoblique, or antero-lateral. In order to facilitate the insertion ofinstruments perpendicular to the face of the glenoid, the surgeon mayfind it necessary to resect the articular portion of the humeral headand forcefully retract the patient's skin, muscle and remaining humerusout of the way posteriorly to obtain adequate exposure. In doing so, thesurgeon may potentially injure nerves or blood vessels. Often thesurgeon will purposely cut the biceps tendon or portions of thepectoralis major tendon to improve exposure to facilitate this step, aswell as releasing the glenohumeral ligaments. All of this dissection,retraction, and removal of bone and soft tissue is done in order toallow the surgeon enough room to implant the glenoid prostheticcomponent.

Thus, there is a need for an implant anchoring mechanism that can beinserted from an oblique angle to allow for a less invasive andtechnically simpler surgical operation, for example, for anchoring aglenoid prosthetic component to scapular bone.

The present disclosure sets forth an oblique-insertion anchoringmechanism for securing a glenoid prosthetic component to scapular bone.The anchoring mechanism can be inserted from an oblique angle to allowfor a less invasive and technically simpler surgical operation. Theanchoring mechanism is formed from a rounded dowel which projects fromthe medial aspect of a glenoid prosthetic component. The dowel projectsat an angle which is not perpendicular to, or normal to, the medial sideof the glenoid component, but is instead an acute angle less than 90degrees. In the acute angle between the dowel and the medial side of theglenoid component there is a triangular reinforcement plate whichbuttresses the dowel and arises at a supplementary angle from the medialside of the glenoid component. The dowel and the edge of thereinforcement plate meet at the apex of the triangle.

It is contemplated that the number and location or placement of theanchoring elements will vary to accommodate different clinicalsituations.

The anchoring elements disclosed herein may be placed peripherally in aring orientation, avoiding a bony central defect. Anchoring elementsplaced more peripherally provide more resistance to the effects of shearforces caused by the pressure of the humeral head during edge loading,as the distance and resultant lever arm decrease.

Biomechanically, the triangular arrangement of the dowel with thereinforcement plate allows the anchoring element to stabilize the bodyof the prosthesis from both legs of the triangular base to protectagainst both anterior and posterior eccentric forces. The triangularbase of the anchoring element provides balanced anchoring to resist theanterior and posterior directed forces. The disclosed technology hasfixation at both legs of the triangle, symmetric in distance from theedges of the body of the prosthesis, and all along the base of thetriangle as well. The triangular shape also provides much larger surfacearea to resist superior and inferior directed forces than pegs alone.This is in contrast to a simple obliquely oriented peg which places thepoint of fixation of implant off center, allowing liftoff at the sidefarthest from the peg.

The disclosed design of the anchoring element may be even morepreferable than traditional designs when glenoid deformity is present.Glenoid retroversion and glenoid vault bone loss are commonly seen incases of advanced arthritis and the present design better fits the bonyanatomy in these cases. This technology may also be preferable forrevision glenoid arthroplasty operations.

The anchoring elements disclosed herein allow the prosthetic componentto be inserted at an oblique angle. Therefore, there is less need toforcefully retract bone or soft tissues to obtain adequate exposure. Thesurgeon may be able to implant the prosthetic component without cuttingthe pectoralis major, the biceps tendon, or the glenohumeral ligaments.These tendons and ligaments serve as static and dynamic stabilizers ofthe humeral head during normal motion. If left intact, humeral motionremains more controlled and centered, reducing the incidence of humeraltranslation and contact with the far peripheral edges of the glenoidcomponent. Reducing edge-loading results in less loosening forcestransmitted to the anchoring elements, which is a common mode of failureof glenoid prosthetic components and total shoulder arthroplastyoverall. Furthermore, the surgeon may not be compelled to resect thehumeral head and may choose instead to use a bone-preserving humeralresurfacing arthroplasty component during the operation, which mayfurther reduce operative time, blood loss and bone removal.

The inferior chamfer design of the lateral bearing surface of theglenoid component minimizes the incidence of impingement between thehumeral component and the inferior articular margin of the glenoidprosthesis, thus reducing the likelihood of implant loosening and wear.Humeral impingement on the inferior glenoid is reported to be a cause ofimplant loosening and wear. Retrieval studies of loose failed glenoidimplants have repeatedly demonstrated deformation at this inferiorlocation.

For at least these reasons, the disclosed technology may simplify theoperation, shorten the length of the operation, reduce soft-tissuedissection, reduce risk of neurovascular injury, reduce blood loss,reduce the need for bone resection, and may improve implant longevity.

Preservation of soft-tissues in glenoid preparation, optionally combinedwith the use of a humeral resurfacing component, may make shoulderarthroplasty more appealing for younger patients with significantdegenerative disease, a patient group currently generally discouragedfrom undergoing shoulder arthroplasty.

An objective of the technology is to disclose a unique positioning of adowel with planar buttress element in a glenoid prosthetic component.

Another objective of the technology is to disclose an improved glenoidprosthetic component that permit placement of anchoring elements inlocations to better replicate normal human anatomy.

Yet another objective of the technology is to disclose an improvedglenoid component that is inserted obliquely.

Yet another objective of the technology is to disclose an improvedglenoid component having a dowel designed to match the specific anatomicshape of the surrounding bone.

Yet another objective of the technology is to disclose an improvedglenoid prosthetic component having unique differential radius ofcurvature in the superior-inferior and anterior-posterior directions.

Yet another objective of the technology is to disclose an improvedglenoid prosthetic component having a unique inferior chamfer.

Other objectives and advantages of this technology will become apparentfrom the following description taken in conjunction with theaccompanying drawings which illustrate examples of this technology. Thedrawings constitute a part of this specification and include examples ofthe present technology and illustrate various objects and featuresthereof.

BRIEF DESCRIPTION OF THE DRAWINGS

While examples of the present technology are shown and described indetail below, it will be clear to the person skilled in the art thatvariations, changes and modifications may be made without departing fromits scope. As such, that which is set forth in the following descriptionand accompanying drawings is offered by way of illustration only and notas a limitation. The actual scope of the invention is intended to bedefined by the following claims, along with the full range ofequivalents to which such claims are entitled.

Identical reference numerals do not necessarily indicate an identicalstructure. Rather, the same reference numeral may be used to indicate asimilar feature or a feature with similar functionality. Not everyfeature of each example is labeled in every figure in which that exampleappears, in order to keep the figures clear. Similar reference numbers(e.g., those that are identical except for the first numeral) are usedto indicate similar features in different examples.

FIG. 1A is a superior-posterior-medial view of a glenoid component; FIG.1B is a superior-anterior-medial view of the glenoid component of FIG.1A,; FIG. 1C is a medial view of the glenoid component of FIG. 1A; FIG.1D is an inferior-posterior-medial view of the oglenoid component ofFIG. 1A; and FIG. 1E is an inferior-anterior-medial view of the glenoidcomponent of FIG. 1A;

FIG. 2A is a superior-anterior-lateral view of the glenoid component ofFIG. 1A; FIG. 2B is a superior-posterior-lateral view of the glenoidcomponent of FIG. 1A; FIG. 2C is a lateral view of the glenoid componentof FIG. 1A; FIG. 2D is an inferior-anterior-lateral view of the glenoidcomponent of FIG. 1A; and FIG. 2E is an inferior-posterior-lateral viewof the glenoid component of FIG. 1A;

FIG. 3A is a superior view of the glenoid component of FIG. 1A; FIG. 3Bis an anterior view of the glenoid component of FIG. 1A; FIG. 3C is alateral view of the glenoid component of FIG. 1A; FIG. 3D is a posteriorview of the glenoid component of FIG. 1A; and FIG. 3E is an inferiorview of the glenoid component of FIG. 1A;

FIG. 4A is a superior-posterior-medial view of the glenoid component ofFIG. 1A; FIG. 4B is a superior-anterior-medial view of the glenoidcomponent of FIG. 1A; FIG. 4C is a medial view of the glenoid componentof FIG. 1A; FIG. 4D is a cross sectional view of the glenoid componentof FIG. 1A, taken along section line 4D-4D of FIG. 4C; FIG. 4E is ananterior partial cross sectional view of the glenoid component of FIG.1A, taken along section line 4E-4E of FIG. 4C; and FIG. 4F is a superiorview of the glenoid component of FIG. 1A;

FIG. 5A is a lateral view of the glenoid component of FIG. 1A and aportion of a scapula, the glenoid component operatively implanted in thescapula; FIG. 5B is an anterior view of the glenoid component andscapula of FIG. 5A; FIG. 5C is an inferior view of the glenoid componentand scapula of FIG. 5A; FIG. 5D is an anterior-lateral view of theglenoid component and scapula of FIG. 5A; FIG. 5E is a cross sectionalview of the glenoid component and scapula of FIG. 5A, taken alongsection line 5E-5E of FIG. 5B; FIG. 5F is a cross sectional view of theglenoid component and scapula of FIG. 5A, taken along section line 5F-5Fof FIG. 5B; and FIG. 5G is a cross sectional view of the glenoidcomponent and scapula of FIG. 5A, taken along section line 5G-5G of FIG.5B;

FIG. 6A is a superior-posterior-medial view of another glenoidcomponent; FIG. 6B is a superior-anterior-medial view of the glenoidcomponent of FIG. 6A,; FIG. 6C is a medial view of the glenoid componentof FIG. 6A; FIG. 6D is an inferior-posterior-medial view of the glenoidcomponent of FIG. 6A; and FIG. 6E is an inferior-anterior-medial view ofthe glenoid component of FIG. 6A;

FIG. 7A is a superior-anterior-lateral view of the glenoid component ofFIG. 6A; FIG. 7B is a superior-posterior-lateral view of the glenoidcomponent of FIG. 6A; FIG. 7C is a lateral view of the glenoid componentof FIG. 6A; FIG. 7D is an inferior-anterior-lateral view of the glenoidcomponent of FIG. 6A; and FIG. 7E is an inferior-posterior-lateral viewof the glenoid component of FIG. 6A;

FIG. 8A is a superior view of the glenoid component of FIG. 6A; FIG. 8Bis an anterior view of the glenoid component of FIG. 6A; FIG. 8C is alateral view of the glenoid component of FIG. 6A; FIG. 8D is a posteriorview of the glenoid component of FIG. 6A; and FIG. 8E is an inferiorview of the glenoid component of FIG. 6A;

FIG. 9A is a superior-posterior-medial view of the glenoid component ofFIG. 6A; FIG. 9B is a superior-anterior-medial view of the glenoidcomponent of FIG. 6A; FIG. 9C is a medial view of the glenoid componentof FIG. 6A; FIG. 9D is a cross sectional view of the glenoid componentof FIG. 6A, taken along section line 9D-9D of FIG. 9C; FIG. 9E is ananterior partial cross sectional view of the glenoid component of FIG.6A, taken along section line 9E-9E of FIG. 9C; and FIG. 9F is a superiorview of the glenoid component of FIG. 6A;

FIG. 10A is a lateral view of the glenoid component of FIG. 6A and aportion of a scapula, the glenoid component operatively implanted in thescapula; FIG. 10B is an anterior view of the glenoid component andscapula of FIG. 10A; FIG. 10C is an inferior view of the glenoidcomponent and scapula of FIG. 10A; FIG. 10D is an anterior-lateral viewof the glenoid component and scapula of FIG. 10A; FIG. 10E is a crosssectional view of the glenoid component and scapula of FIG. 10A, takenalong section line 10E-10E of FIG. 10B; FIG. 1OF is a cross sectionalview of the glenoid component and scapula of FIG. 10A, taken alongsection line 10F-10F of FIG. 10B; and FIG. 10G is a cross sectional viewof the glenoid component and scapula of FIG. 10A, taken along sectionline 10G-10G of FIG. 10B;

FIG. 11A is a superior-posterior-medial view of yet another glenoidcomponent; FIG. 11B is a superior-anterior-medial view of the glenoidcomponent of FIG. 11A,; FIG. 11C is a medial view of the glenoidcomponent of FIG. 11A; FIG. 11D is an inferior-posterior-medial view ofthe glenoid component of FIG. 11A; and FIG. 11E is aninferior-anterior-medial view of the glenoid component of FIG. 11A;

FIG. 12A is a superior-anterior-lateral view of the glenoid component ofFIG. 11A; FIG. 12B is a superior-posterior-lateral view of the glenoidcomponent of FIG. 11A; FIG. 12C is a lateral view of the glenoidcomponent of FIG. 11A; FIG. 12D is an inferior-anterior-lateral view ofthe glenoid component of FIG. 11A; and FIG. 12E is aninferior-posterior-lateral view of the glenoid component of FIG. 11A;

FIG. 13A is a superior view of the glenoid component of FIG. 11A; FIG.13B is an anterior view of the glenoid component of FIG. 11A; FIG. 13Cis a lateral view of the glenoid component of FIG. 11A; FIG. 13D is aposterior view of the glenoid component of FIG. 11A; and FIG. 13E is aninferior view of the glenoid component of FIG. 11A;

FIG. 14A is a superior-posterior-medial view of the glenoid component ofFIG. 11A; FIG. 14B is a superior-anterior-medial view of the glenoidcomponent of FIG. 11A; FIG. 14C is a medial view of the glenoidcomponent of FIG. 11A; FIG. 14D is a cross sectional view of the glenoidcomponent of FIG. 11A, taken along section line 14D-14D of FIG. 14C;FIG. 14E is an anterior partial cross sectional view of the glenoidcomponent of FIG. 11A, taken along section line 14E-14E of FIG. 14C; andFIG. 14F is a superior view of the glenoid component of FIG. 11A;

FIG. 15A is a lateral view of the glenoid component of FIG. 11A and aportion of a scapula, the glenoid component operatively implanted in thescapula; FIG. 15B is an anterior view of the glenoid component andscapula of FIG. 15A; FIG. 15C is an inferior view of the glenoidcomponent and scapula of FIG. 15A; FIG. 15D is an anterior-lateral viewof the glenoid component and scapula of FIG. 15A; FIG. 15E is a crosssectional view of the glenoid component and scapula of FIG. 15A, takenalong section line 15E-15E of FIG. 15B; FIG. 15F is a cross sectionalview of the glenoid component and scapula of FIG. 15A, taken alongsection line 15F-15F of FIG. 15B; and FIG. 15G is a cross sectional viewof the glenoid component and scapula of FIG. 15A, taken along sectionline 15G-15G of FIG. 15B;

FIG. 16A is a superior-posterior-medial view of yet another glenoidcomponent; FIG. 16B is a posterior view of the glenoid component of FIG.16A; FIG. 16C is an inferior view of the glenoid component of FIG. 16A;FIG. 16D is a medial view of the glenoid component of FIG. 16A; FIG. 16Eis a cross sectional view of the glenoid component of FIG. 16A, takenalong section line 16E-16E of FIG. 16D; and FIG. 16F is an anterior viewof the glenoid component of FIG. 16A;

FIG. 17A is a superior-posterior-medial view of yet another glenoidcomponent; FIG. 17B is a posterior view of the glenoid component of FIG.17A; FIG. 17C is an inferior view of the glenoid component of FIG. 17A;FIG. 17D is a medial view of the glenoid component of FIG. 17A; FIG. 17Eis a cross sectional view of the glenoid component of FIG. 17A, takenalong section line 17E-17E of FIG. 17D; and FIG. 17F is an anterior viewof the glenoid component of FIG. 17A;

FIG. 18A is a superior-posterior-medial view of yet another glenoidcomponent; FIG. 18B is a posterior view of the glenoid component of FIG.18A; FIG. 18C is an inferior view of the glenoid component of FIG. 18A;FIG. 18D is a medial view of the glenoid component of FIG. 18A; FIG. 18Eis a cross sectional view of the glenoid component of FIG. 18A, takenalong section line 18E-18E of FIG. 18D; and FIG. 18F is an anterior viewof the glenoid component of FIG. 18A;

FIG. 19A is an inferior-anterior-medial view of yet another glenoidcomponent; FIG. 19B is an inferior-posterior-medial view of the glenoidcomponent of FIG. 19A; FIG. 19C is a superior-anterior-lateral view ofthe glenoid component of FIG. 19A; FIG. 19D is a lateral view of theglenoid component of FIG. 19A; FIG. 19E is a medial view of the glenoidcomponent of FIG. 19A; FIG. 19F is an anterior view of the glenoidcomponent of FIG. 19A; FIG. 19G is a posterior view of the glenoidcomponent of FIG. 19A; FIG. 19H is an inferior view of the glenoidcomponent of FIG. 19A; FIG. 191 is a superior view of the glenoidcomponent of FIG. 19A; FIG. 19J is a medial view of the glenoidcomponent of FIG. 19A; FIG. 19K is a cross sectional view of the glenoidcomponent of FIG. 19J, taken along section line 19K-19K of FIG. 19J; andFIG. 19L is a cross sectional view of the glenoid component of FIG. 19J,taken along section line 19L-19L of FIG. 19J;

FIG. 20A is an isometric view of a size template; and FIG. 20B is adetail view of a working portion of the size template of FIG. 20A;

FIG. 21A is an isometric view of a reamer; and FIG. 21B is anotherisometric view of the reamer of FIG. 21A from a different direction;

FIG. 22A is an isometric view of a drill guide; FIG. 22B is anotherisometric view of the drill guide of FIG. 22A from a differentdirection; FIG. 22C is a side view of the drill guide of FIG. 22A; FIG.22D is yet another isometric view of the drill guide of FIG. 22A from adifferent direction; FIG. 22E is yet another isometric view of the drillguide of FIG. 22A from a different direction; FIG. 22F is another sideview of the drill guide of FIG. 22A; FIG. 22G is a projected view of thedrill guide of FIG. 22A, from projection line 22G-22G of FIG. 22F; FIG.22H is yet another isometric view of the drill guide of FIG. 22A from adifferent direction; FIG. 22I is a detail view of a working portion ofthe drill guide of FIG. 22A, as indicated by detail circle 221 of FIG.22E; and FIG. 22J is a detail view of a working portion of the drillguide of FIG. 22A, as indicated by detail circle 22J of FIG. 22H;

FIG. 23A is an isometric view of another drill guide with a drill and akeel position tamp; and FIG. 23B is another isometric view of the drillguide, drill, and keel position tamp of FIG. 23A from a differentdirection;

FIG. 24A is an isometric view of yet another drill guide; FIG. 24B isanother isometric view of the drill guide of FIG. 24A from a differentdirection; FIG. 24C is a side view of the drill guide of FIG. 24A; FIG.24D is yet another isometric view of the drill guide of FIG. 24A from adifferent direction; FIG. 24E is yet another isometric view of the drillguide of FIG. 24A from a different direction; FIG. 24F is another sideview of the drill guide of FIG. 24A; FIG. 24G is a projected view of thedrill guide of FIG. 24A, from projection line 24G-24G of FIG. 24F; FIG.24H is yet another isometric view of the drill guide of FIG. 24A from adifferent direction; FIG. 241 is a detail view of a working portion ofthe drill guide of FIG. 24A, as indicated by detail circle 241 of FIG.24E; FIG. 24J is a detail view of a working portion of the drill guideof FIG. 24A, as indicated by detail circle 24J of FIG. 24H; FIG. 24K isan enlarged detail view of a portion of the drill guide of FIG. 24A; andFIG. 24L is an enlarged detail view of a portion of the drill guide ofFIG. 24A;

FIG. 25A is an isometric view of yet another drill guide with drills;and FIG. 25B is another isometric view of the drill guide and drills ofFIG. 25A from a different direction;

FIG. 26A is an isometric view of yet another drill guide with a drill;and FIG. 26B is another isometric view of the drill guide and drills ofFIG. 26A from a different direction;

FIG. 27A is an isometric view of a punch; FIG. 27B is another isometricview of the punch of FIG. 27A from a different direction; FIG. 27C is aside view of the punch of FIG. 27A; FIG. 27D is yet another isometricview of the punch of FIG. 27A from a different direction; FIG. 27E isyet another isometric view of the punch of FIG. 27A from a differentdirection; FIG. 27F is another side view of the punch of FIG. 27A; FIG.27G is yet another isometric view of the punch of FIG. 27A from adifferent direction; FIG. 27H is a detail view of a working portion ofthe punch of FIG. 27A, as indicated by detail circle 27H of FIG. 27E;and FIG. 271 is a detail view of a working portion of the punch of FIG.27A, as indicated by detail circle 271 of FIG. 27G;

FIG. 28A is an isometric view of a broach; FIG. 28B is a detail view ofa working portion of the broach of FIG. 28A; and FIG. 28C is anotherdetail view of a working portion of the broach of FIG. 28A from adifferent direction;

FIG. 29 is an anterior view of a right shoulder joint with a scapula anda humerus;

FIG. 30 is an isometric view of the shoulder joint of FIG. 29 with thesize template of FIG. 20A;

FIG. 31 is an isometric view of the scapula of FIG. 29 after sizing;

FIG. 32 is an isometric view of the scapula of FIG. 29 with the reamerof FIG. 21A;

FIG. 33 is an isometric view of the scapula of FIG. 29 after reaming;

FIG. 34A is an isometric view of the shoulder joint of FIG. 29 with thedrill guide, drill, and keel position tamp of FIG. 23A; FIG. 34B is ananterior view of the shoulder joint, drill guide, drill, and keelposition tamp of FIG. 34A; and FIG. 34C is a cross sectional view of theshoulder joint, drill guide, drill, and keel position tamp of FIG. 34A,taken along section line 34C-34C of FIG. 34B;

FIG. 35 is an isometric view of the scapula of FIG. 29 after a firstdrilling step;

FIG. 36 is an isometric view of the shoulder joint of FIG. 29 with thedrill guide and drills of FIG. 25A;

FIG. 37 is an isometric view of the scapula of FIG. 29 after a seconddrilling step;

FIG. 38 is an isometric view of the shoulder joint of FIG. 29 with thedrill guide and drills of FIG. 26A;

FIG. 39 is an isometric view of the scapula of FIG. 29 after a thirddrilling step;

FIG. 40A is an isometric view of the shoulder joint of FIG. 29 with thebroach of FIG. 28A; FIG. 40B is an anterior view of the shoulder jointand broach of FIG. 40A; and FIG. 40C is a cross sectional view of theshoulder joint and broach of FIG. 40A, taken along section line 40C-40Cof FIG. 40B; and

FIG. 41 is an isometric view of the scapula of FIG. 29 and the glenoidcomponent of FIG. 19A.

DETAILED DESCRIPTION

Standard medical planes of reference and descriptive terminology areemployed in this specification. A sagittal plane divides a body intoright and left portions. A mid-sagittal plane divides the body intobilaterally symmetric right and left halves. A coronal plane divides abody into anterior and posterior portions. A transverse plane divides abody into superior and inferior portions. Anterior means toward thefront of the body. Posterior means toward the back of the body. Superiormeans toward the head. Inferior means toward the feet. Medial meanstoward the midline of the body. Lateral means away from the midline ofthe body. Axial means toward a central axis of the body. Abaxial meansaway from a central axis of the body. Ipsilateral means on the same sideof the body. Contralateral means on the opposite side of the body. Thesedescriptive terms may be applied to an animate or inanimate body.

Referring to FIGS. 1A-4F, a glenoid component 100 includes a body 102with a lateral articular surface 104 and an opposite medial bone-facingsurface 106.

A peripheral wall 108 extends around the body 102 between the surfaces104, 106. A lateral peripheral edge 110 extends around the body 102where the lateral articular surface 104 meets the peripheral wall 108.The lateral peripheral edge 110 may include a lateral peripheral relief112, such as a radius, fillet, chamfer, bevel, or the like. The lateralperipheral relief 112 may reduce point loading of a correspondinghumeral articular surface at the lateral peripheral edge 110. A medialperipheral edge 114 extends around the body 102 where the medialbone-facing surface 106 meets the peripheral wall 108. The medialperipheral edge 114 may include a medial peripheral relief 116, such asa radius, fillet, chamfer, bevel, or the like.

The body 102 may be divided into a superior portion 118, an inferiorportion 120, an anterior portion 122, and a posterior portion 124. Theseterms 118, 120, 122, 124 may also be used in reference to the peripheralwall 108. In examples other than shoulder glenoid components, theappropriate medical directional terms may be readily substituted by oneof skill in the art.

The lateral articular surface 104 may be concave as shown, planar, orconvex in order to complement a natural or prosthetic humeral articularsurface. The lateral articular surface 104 may be spherical.Alternatively, with reference to FIGS. 4C-4E, the lateral articularsurface 104 may have a first radius 126 which is dimensionally differentfrom a second radius 128. The first radius 126 may be larger or smallerthan the second radius 128. In the example shown, the first radius 126lies on a first plane which extends normal to the lateral articularsurface 104 in the superior-inferior and medial-lateral directions andis centered in the anterior-posterior width of the body 102, as can beseen with reference to FIGS. 4C and 4E. The first radius 126 may bereferred to as an S-I radius. The second radius 128 lies on a secondplane which extends normal to the lateral articular surface 104 in theanterior-posterior and medial-lateral directions and is centered in thesuperior-inferior length of the body 102, as can be seen with referenceto FIGS. 4C and 4D. The second radius may be referred to as an A-Pradius. The first and second radii 126, 128 may lie on planes that areeccentrically located relative to the S-I length and A-P width of thebody 102, that intersect at an acute or perpendicular angle, or that areoriented without regard to standard orthogonal planes of reference.

When the first radius 126 is dimensionally different from the secondradius 128, the corresponding humeral articular surface is lessconstrained in the direction of the larger radius. For example, when theS-I radius 126 is larger than the A-P radius 128, the humeral articularsurface is less constrained in the S-I direction than in the A-Pdirection. Less constraint may result in lower eccentric forces appliedto the glenoid articular surface 104, and thus reduced risk of implantloosening. A glenoid articular surface 104 in which the S-I radius 126is larger than the A-P radius 128 may therefore exhibit improvedperformance when tested according to ASTM F-2028, “Standard Test Methodsfor Dynamic Evaluation of Glenoid Loosening or Disassociation.”

The inferior portion 120 of the body 102 may include an inferior chamfer130 which extends between the lateral articular surface 104 and theperipheral wall 108. The inferior chamfer 130 lowers the profile andthickness of the inferior portion 120. This arrangement lessens the riskof impingement between a corresponding humerus and the inferior portion120. The inferior chamfer 130 and rounded edges 112, 116 on the lateralarticular surface 104 may reduce microscopic cracking and wear of thebody 102. This may reduce the formation of particulate debris which isassociated with inflammatory reactions in the local tissue, osteolysis,and component loosening.

The anterior portion 122 of the body 102 may include an anterior relief134 which extends between the lateral articular surface 104 and theperipheral wall 108. The anterior relief 134 lowers the profile andthickness of the anterior portion 122. Similarly, the posterior portion124 of the body 102 may include a posterior relief 136 which extendsbetween the lateral articular surface 104 and the peripheral wall 108.The posterior relief 136 lowers the profile and thickness of theposterior portion 124.

The medial bone-facing surface 106 may be convex as shown, planar, orconcave.

The glenoid component 100 includes at least one anchoring element 138which protrudes outwardly from the medial bone-facing surface 106. Theexample shown includes a superior anchoring element 138, an inferioranchoring element 140, and a middle anchoring element 142, although anynumber of anchoring elements may be present. The middle anchoringelement 142 is positioned slightly anterior to the other anchoringelements 138, 140 in order to more closely match the normal anatomy ofthe glenoid vault. Each anchoring element may be independentlypositioned on the medial bone-facing surface 106, and may beindependently sized.

The anchoring element 138 includes a dowel 148 and a triangularreinforcement plate 152. The dowel may also be referred to as a mast.The reinforcement plate may also be referred to as a sail or buttress.The dowel 148 projects from the medial bone-facing surface 106 at anangle 150 less than ninety degrees and greater than zero degrees. Theangle 150 may be referred to as a dowel angle or a mast angle. Morespecifically, the angle 150 may be measured between a centrallongitudinal axis of the dowel 148 and a plane which is tangent to themedial bone-facing surface 106, if surface 106 is concave or convex, ora plane which is coplanar with the medial bone-facing surface 106, ifsurface 106 is planar. For example, the plane may be tangent to themedial bone-facing surface 106 at an intersection point between thecentral longitudinal axis of the dowel 148 and the medial bone-facingsurface 106, or at a centroid of the medial bone-facing surface 106. Thedowel 148 may project from the anterior portion 122 of the body 102, asshown, or from another portion of the body 102. In the example shown,the dowels 148 of anchoring elements 138, 140, 142 project fromperipheral locations in the anterior portion 122 and terminate inmedially located free ends. The dowel 148 may have a round basic crosssectional shape, as shown, or may be another shape, such as a rectangleor dovetail. The dowel 148 may include a hole (shown in laterembodiments), which may receive a radiographic marker. The reinforcementplate 152 also projects from the medial bone-facing surface 106 in theacute angle 150 between the dowel 148 and the medial bone-facing surface106, coplanar with the dowel 148. An exposed side of the reinforcementplate 152 projects from the medial bone-facing surface 106 at an angle154 less than ninety degrees and greater than zero degrees. The angle154 may be referred to as a supplementary angle or a reinforcementangle. The angle 154 opens toward the angle 150, and the sum of angles150 and 154 is greater than zero degrees and less than one hundredeighty degrees. The reinforcement plate 152 intersects the dowel 148 toform a triangular shape with one side formed by the medial bone-facingsurface 106, one side formed by the dowel 148, and one side formed bythe exposed side of the reinforcement plate 152. The anchoring element138 may include a pedestal 156 or footing which reinforces the base ofthe anchoring element 138 where it joins the medial bone-facing surface106. The pedestal 156 may be described as an enlargement of theanchoring element 138, and may be present on the dowel 148 or thereinforcement plate 152, or both. Pedestal 156 as shown is present onthe dowel 148. The pedestal 156 may terminate in a planar face 157 whichestablishes the plane from which the angles 150, 154 are measured. Theplanar face 157 may be tangent to the medial bone-facing surface 106 ata center point along the medial bone-facing surface side of thetriangular shape.

The anchoring element 138 may include surface features to improve thepull-out strength after implantation. The surface features may bedescribed as fixation features 158, and may include notches, ridges,barbs, threads, or perforations. For example, alternating ridges 160 andgrooves 162 are shown, as well as fenestrations 168 in superior andinferior anchoring elements 138 and 140. All of these surface featuresmay facilitate bony ingrowth or bone cement interdigitation.

A slot 164, or groove or channel may be present along the dowel side ofthe triangular shape, the reinforcement plate side of the triangularshape, or both. In cemented applications of the technology, the bonecement may flow along the slot(s) 164 on the anchoring element tofacilitate more uniform and stronger fixation. The slot(s) 164, orchannels, of the dowel 148 and/or the reinforcement plate 152 permitcement flow and promote cement interdigitation more evenly throughoutthe anchoring element and just below subchondral bone rather thanpushing the cement to the deepest portion of the glenoid vault. In theexample shown, the three-dowel glenoid component includes slots 164along both the dowel side and the reinforcement plate side of thetriangular shape. In other examples, a flat surface may extend along thedowel side of the triangular shape, the reinforcement plate side of thetriangular shape, or both.

Referring to FIGS. 5A-5G, the glenoid component 100 is shown operativelyimplanted in a scapula 2. The scapula 2 includes a glenoid fossa 4, acoracoid process 6, and an acromion process 8. FIGS. 5E-5G show variouscross sections through the glenoid component 100 and the scapula 2. Withreference to FIG. 5G, the triangular shape of the anchoring elementsmatches the conical shape of the glenoid vault more closely than does acentral peg or keel. The triangular anchoring elements may be placedmore peripherally on the glenoid component. The dowels 148 areperipherally arranged along the anterior portion 122 in the exampleshown. This places the base, or pedestal 156, of the anchoring elementsinto regions of denser subchondral bone for stronger fixation. Mediallyin the glenoid vault, the edges of the dowel and planar portions may lieadjacent and parallel to the thick cortical walls of the glenoid vault.Referring to FIG. 5F, the anterior location of the middle anchor element142 more closely matches normal anatomy and allows the anchor element142 to fit more precisely within the normal shape of the glenoid vault,due to the spinoglenoid notch. Better fit may result in reducedincidence of glenoid vault perforation by instruments and/or bone cementleakage through the cortical bone of the scapula into surrounding softtissues.

Referring to FIGS. 6A-9F, a glenoid component 200 includes a body 202with a lateral articular surface 204 and an opposite medial bone-facingsurface 206. Glenoid component 200 includes the following features,which may be substantially similar to, or the same as, the correspondingfeatures of glenoid component 100: peripheral wall 208, lateralperipheral edge 210, lateral peripheral relief 212, medial peripheraledge 214, medial peripheral relief 216, superior portion 218, inferiorportion 220, anterior portion 222, posterior portion 224, S-I radius ofcurvature 226, A-P radius of curvature 228, inferior chamfer 230,anterior relief 234, posterior relief 236, superior anchoring element238, inferior anchoring element 240, middle anchoring element 242, dowelor mast 248, mast angle 250, triangular reinforcement plate or sail 252,supplementary angle 254, pedestal 256, face 257, fixation feature 258,ridge 260, groove 262, and fenestration 268. Glenoid component 200 alsoincludes a chamfer blend radius 232 and a hole 270. The chamfer blendradius 232 is adjacent to the inferior chamfer 230. The chamfer blendradius 232 is more centrally located than is the inferior chamfer 230.The hole 270 extends lengthwise into the dowel 248 of middle anchoringelement 242, and may receive a radiographic marker (not shown). Glenoidcomponent 200 lacks a slot, channel, or groove comparable to slot 164.

Referring to FIGS. 10A-10G, the glenoid component 200 is shownoperatively implanted in a scapula 2. Referring to FIG. 10B, theanchoring elements 238, 240, 242 protrude from the medial bone-facingsurface 206 at a slight acute angle in the coronal plane.

Referring to FIGS. 11A-14F, a glenoid component 300 includes a body 302with a lateral articular surface 304 and an opposite medial bone-facingsurface 306. Glenoid component 300 includes the following features,which may be substantially similar to, or the same as, the correspondingfeatures of glenoid component 100: peripheral wall 308, lateralperipheral edge 310, lateral peripheral relief 312, medial peripheraledge 314, medial peripheral relief 316, superior portion 318, inferiorportion 320, anterior portion 322, posterior portion 324, S-I radius ofcurvature 326, A-P radius of curvature 328, inferior chamfer 330,anterior relief 334, posterior relief 336, superior anchoring element338, inferior anchoring element 340, middle anchoring element 342, dowelor mast 348, mast angle 350, triangular reinforcement plate or sail 352,supplementary angle 354, fixation feature 358, ridge 360, groove 362,and fenestration 368. Glenoid component 300 also includes a flat surface366 extending along the reinforcement plate side of the triangular shapeinstead of a slot, channel, or groove comparable to slot 164. Glenoidcomponent 300 lacks a well-defined pedestal, although a face 357 ispresent at the base of the dowel 348.

Referring to FIGS. 15A-15G, the glenoid component 300 is shownoperatively implanted in a scapula 2.

Referring to FIGS. 16A-16F, a glenoid component 400 includes a body 402with a lateral articular surface 404 and an opposite medial bone-facingsurface 406. Glenoid component 400 includes the following features,which may be substantially similar to, or the same as, the correspondingfeatures of glenoid component 100: peripheral wall 408, lateralperipheral edge 410, lateral peripheral relief 412, medial peripheraledge 414, medial peripheral relief 416, superior portion 418, inferiorportion 420, anterior portion 422, posterior portion 424, S-I radius ofcurvature 426, A-P radius of curvature 428, superior anchoring element438, inferior anchoring element 440, middle anchoring element 442, dowelor mast 448, mast angle 450, triangular reinforcement plate or sail 452,and supplementary angle 454. The middle anchoring element 442 is offsetposteriorly so that its dowel 448 projects from a more medial or centrallocation than do the dowels of anchoring elements 438, 440, 138, 140,142, 238, 240, 242, 338, 340, 342. Dowel 448 of anchoring element 442also terminates in a more laterally located free end. However, thereinforcement plate 452 remains located in the acute mast angle 450.Glenoid component 400 lacks an inferior chamfer, anterior relief,posterior relief, pedestal, face, fixation feature, ridge, groove, slot,flat surface, or fenestration.

Referring to FIGS. 17A-17F, a glenoid component 500 includes a body 502with a lateral articular surface 504 and an opposite medial bone-facingsurface 506. Glenoid component 500 includes the following features,which may be substantially similar to, or the same as, the correspondingfeatures of glenoid component 100: peripheral wall 508, lateralperipheral edge 510, medial peripheral edge 514, superior portion 518,inferior portion 520, anterior portion 522, posterior portion 524, S-Iradius of curvature 526, A-P radius of curvature 528, superior anchoringelement 538, inferior anchoring element 540, dowel or mast 548, mastangle 550, triangular reinforcement plate or sail 552, supplementaryangle 554. Glenoid component 500 lacks a lateral peripheral relief,medial peripheral relief, inferior chamfer, anterior relief, posteriorrelief, middle anchoring element, pedestal, face, fixation feature,ridge, groove, slot, flat surface, or fenestration.

Referring to FIGS. 18A-18F, a glenoid component 600 includes a body 602with a lateral articular surface 604 and an opposite medial bone-facingsurface 606. Glenoid component 600 includes the following features,which may be substantially similar to, or the same as, the correspondingfeatures of glenoid component 100: peripheral wall 608, lateralperipheral edge 610, lateral peripheral relief 612, medial peripheraledge 614, medial peripheral relief 616, superior portion 618, inferiorportion 620, anterior portion 622, posterior portion 624, S-I radius ofcurvature 626, A-P radius of curvature 628, superior anchoring element638, inferior anchoring element 640, middle anchoring element 642, dowelor mast 648, mast angle 650, triangular reinforcement plate or sail 652,and supplementary angle 654. Glenoid component 600 also includes amid-superior anchoring element 644 between anchoring elements 638, 642and a mid-inferior anchoring element 646 between anchoring elements 640,642. The anchoring elements 644, 646 are offset posteriorly so thattheir dowels 448 project from medial or central locations as describedabove for anchoring element 442 of glenoid component 400. Glenoidcomponent 600 lacks an inferior chamfer, anterior relief, posteriorrelief, pedestal, face, fixation feature, ridge, groove, slot, flatsurface, or fenestration.

Referring to FIGS. 19A-19L, a glenoid component 700 includes a body 702with a lateral articular surface 704 and an opposite medial bone-facingsurface 706. Glenoid component 700 includes the following features,which may be substantially similar to, or the same as, the correspondingfeatures of glenoid component 100: peripheral wall 708, lateralperipheral edge 710, lateral peripheral relief 712, medial peripheraledge 714, medial peripheral relief 716, superior portion 718, inferiorportion 720, anterior portion 722, posterior portion 724, S-I radius ofcurvature 726, A-P radius of curvature 728, inferior chamfer 730,superior anchoring element 738, inferior anchoring element 740, middleanchoring element 742, dowel or mast 748, mast angle 750, triangularreinforcement plate or sail 752, supplementary angle 754, pedestal 756,face 757, fixation features 758, ridge 760, groove 762, slot 764, flatsurface 766, and fenestration 768. Glenoid component 700 also includes achamfer blend radius 732 and a hole 770. The chamfer blend radius 732 isadjacent to the inferior chamfer 730. The chamfer blend radius 732 ismore centrally located than is the inferior chamfer 730. The hole 770extends lengthwise into the dowel 748 of middle anchoring element 742,and may receive a radiographic marker (not shown). Glenoid component 700lacks an anterior relief or a posterior relief.

Referring now to FIGS. 20A-28C, instruments for use with the disclosedglenoid prostheses will now be described.

Referring to FIGS. 20A-20B, a size template 1200 includes a handle 1202,a shaft 1204, and a working portion 1206. The handle 1202 and theworking portion 1206 are arranged at opposite ends of the shaft 1204,which is straight in this example. The working portion 1206 includes abody 1208 with a first surface 1210 and an opposite bone-facing surface1212. The bone-facing surface 1212 may match the bone-facing surface106, 206, 306, 406, 506, 706 of one of the glenoid components. The body1208 is oriented at an obtuse angle relative to the shaft 1204. Theobtuse angle is greater than ninety degrees and less than one hundredeighty degrees. A peripheral wall 1214 extends around the body 1208between the surfaces 1210, 1212. The body 1208 includes a central hole1216. The central hole 1216 includes a conical portion 1218 that extendsthrough the first surface 1210, and a cylindrical portion 1220 thatextends through the bone-facing surface. The body 1208 may include oneor more apertures; the example shown includes four apertures 1222, 1224,1226, 1228 which may let the user see portions of a bone surface againstwhich the body 1208 rests. The central hole 1216 in the illustratedexample is supported in the midst of the apertures 1222, 1224, 1226,1228 by at least one rib; four ribs 1230, 1232, 1234, 1236 are shown.The central hole 1216 is encircled by a ring 1238 in this example. Thebody 1208 may be described as forming a loop 1240 bounded externally bythe peripheral wall 1214 and internally by an inner wall 1242, which isintersected by the at least one rib.

Referring to FIGS. 21A-21B, a reamer 1300 includes a coupling 1302, ashaft 1304, and a working portion 1306. The coupling 1302 and theworking portion 1306 are arranged at opposite ends of the shaft 1304,which is straight in this example. The coupling 1302 connects the reamer1300 to a torque source, such as a power handpiece or a T-handle, sothat the reamer 1300 may be rotated or spun about a central longitudinalaxis of the shaft 1304 by the torque source. The working portion 1306includes a body 1308 with a first surface 1310 and an oppositebone-facing surface 1312. The bone-facing surface 1312 may match thebone-facing surface 106, 206, 306, 406, 506, 706 of one of the glenoidcomponents. The body 1308 may be described as bi-lobular, the two lobes1314, 1316 established by opposing indentations 1318, 1320. In otherexamples, the body 1308 may be round or nearly round. The bone-facingsurface 1312 includes bone removal features 1322, which may be teeth,serrations, ridges and grooves, knurling, a sandpaper texture, or thelike. In the example shown, the bone removal features 1322 arealternating ridges 1324 and grooves 1326. The cutting edges of theridges 1324 are interrupted or scored by cross grooves 1328. The boneremoval features 1322 on lobe 1314 are oriented opposite to the boneremoval features 1322 on lobe 1316 so that the bone removal features1322 on each lobe 1314, 1316 are oriented to efficiently remove bone asthe reamer 1300 spins in one direction. A trough 1330 separates the boneremoval features 1322 on lobe 1314 from the bone removal features 1322on lobe 1316. A drill tip 1332 protrudes from the bone-facing surface1312. The drill tip 1332 may be end-cutting, side-cutting, or both; anend-cutting example is shown. A second, larger diameter, drill feature1334 may protrude from the bone-facing surface 1312 around the base ofthe drill tip 1332. The drill feature 1334 may be end-cutting,side-cutting, or both; an end-cutting example is shown.

The recipient site on the scapula can be prepared quickly using amatched-design cutting jig with adjacent slots for drill bits and/orburrs or oscillating saw blades, all of which are instruments commonlyused by orthopedic surgeons. The matched-design recipient holepreparation jig includes a handle to be held by the operating surgeon.The handle is attached to a drill guide that has openings that match thenumber and location of the anchoring elements that are present on thechosen glenoid prosthetic component. When the drill guide is placedflush against the glenoid bony surface, the angle of the drill guideopening matches the dowel angle 150, 250, 350, 450, 550, 650, 750.

Referring to FIGS. 22A-22J, a drill guide 1400 includes a handle 1402, ashaft 1404, and a working portion 1406. The handle 1402 and the workingportion 1406 are arranged at opposite ends of the shaft 1404, which isstraight in this example. The working portion 1406 includes a body 1408with a first surface 1410 and an opposite bone-facing surface 1412. Thebone-facing surface 1412 may match the bone-facing surface 106, 206,306, 406, 506, 706 of one of the glenoid components. The body 1408 isoriented at an obtuse angle relative to the shaft 1404. The obtuse angleis greater than ninety degrees and less than one hundred eighty degrees.The body 1408 includes at least one hole whose size, location, and anglerelative to the bone-facing surface 1412 correspond to the size,location, and angle of the dowel of one of the previously describedanchoring elements. While the present example is shown with three holes1414, 1416, 1418 corresponding to a three-anchor glenoid component,other examples may have a different number or arrangement of holescorresponding to another glenoid component. The body 1408 may include aprotrusion 1420 extending from the first surface 1410 around the holes1414, 1416, 1418 to increase the length of the holes. A central hole1426 extends through the body 1408 normal to the bone-facing surface1412. One or more spikes 1428 may protrude from the bone-facing surface1412. One or more apertures 1430 may extend through the body 1408 toprovide a visualization window for the user. The body 1408 may resembleone of the previously-described glenoid components, as illustrated inFIGS. 22A-22J. Alternatively, the body 1408 may include only enoughmaterial to form or surround the surfaces, hole(s), and/or protrusiondescribed above.

Referring to FIGS. 23A-23B, another drill guide 1500 includes a handle1502, a shaft 1504, and a working portion 1506. The shaft 1504 is bent,or zig-zag, in this example. Drill guide 1500 includes the followingfeatures, which may be substantially similar to, or the same as, thecorresponding features of drill guide 1400: body 1508, first surface1510, bone-facing surface 1512, hole 1514, hole 1516, hole 1518,protrusion 1520, aperture 1530. Drill guide 1500 also includes centralpeg 1526, which projects from the body 1508 normal to the bone-facingsurface 1512. Drill guide 1500 lacks a central hole or a spike.

Drill guide 1500 is shown with a drill 1590 in hole 1514 and a keelposition tamp 1580 in hole 1516. The drill 1590 and keel position tamp1580 are interchangeably received in holes 1514, 1516, 1518. The drill1590 forms a hole sized to receive a dowel. In one example, the drill1590 may form a 6.0 mm hole. The keel position tamp 1580 may also bereferred to as a locator pin or peg.

Referring to FIGS. 24A-24J, yet another drill guide 1600 includes ahandle 1602, a shaft 1604, and a working portion 1606. The shaft 1604 isstraight in this example. Drill guide 1600 includes the followingfeatures, which may be substantially similar to, or the same as, thecorresponding features of drill guide 1400: body 1608, first surface1610, bone-facing surface 1612, hole 1614, hole 1616, hole 1618,protrusion 1620, spike 1628. Drill guide 1600 also includes protrusion1622, protrusion 1624, holes 1632, 1634, 1636, 1638, 1640, 1642, andpegs 1644, 1646, 1648. Peg 1644 and holes 1614, 1632, 1638 form a linewith each hole partially overlapping the adjacent peg or hole(s). Inthis example, protrusion 1620 extends from the first surface 1610 aroundthe holes 1614, 1632, 1638. Peg 1646 and holes 1616, 1634, 1640 form aline with each hole partially overlapping the adjacent peg or hole(s).Protrusion 1622 extends from the first surface 1610 around the holes1616, 1634, 1640. Peg 1648 and holes 1618, 1636, 1642 form a line witheach hole partially overlapping the adjacent peg or hole(s). Protrusion1624 extends from the first surface 1610 around the holes 1618, 1636,1642. Drill guide 1600 lacks a central hole or an aperture. It iscontemplated that some examples of guide 1600 may include elongatedslots, similar to the apertures 1930, 1932 of the broach 2000 presentedbelow, instead of the illustrated arrangement of partially overlappingholes, Such slots may receive cutting tools such as saw blades, burrs,punches, osteotomes, and/or curettes, as well as drills.

Referring to FIGS. 25A-25B, yet another drill guide 1700 includes ahandle 1702, a shaft 1704, and a working portion 1706. The shaft 1704 isbent, or zig-zag, in this example. Drill guide 1700 includes thefollowing features, which may be substantially similar to, or the sameas, the corresponding features of drill guide 1400: body 1708, firstsurface 1710, bone-facing surface 1712, hole 1714, hole 1716, hole 1718,and protrusion 1720. Drill guide 1700 also includes protrusion 1722,protrusion 1724, holes 1732, 1734, 1736, and pegs 1744, 1746, 1748. Peg1744 and holes 1714, 1732 form a line with each hole partiallyoverlapping the adjacent peg or hole. In this example, protrusion 1720extends from the first surface 1710 around the holes 1714, 1732. Peg1746 and holes 1716, 1734 form a line with each hole partiallyoverlapping the adjacent peg or hole. Protrusion 1722 extends from thefirst surface 1710 around the holes 1716, 1734. Peg 1748 and holes 1718,1736 form a line with each hole partially overlapping the adjacent pegor hole. Protrusion 1724 extends from the first surface 1710 around theholes 1718, 1736. Drill guide 1700 lacks a central hole, an aperture, ora spike.

Drill guide 1700 is shown with a drill 1790 in hole 1714 and anotherdrill 1790 in hole 1736. Drill 1790 is interchangeably received in holes1714, 1716, 1718, 1732, 1734, 1736. The drill 1790 forms a hole sized toreceive a portion of a triangular reinforcement plate. In one example,the drill 1790 may form a 4.5 mm hole.

Referring to FIGS. 26A-26B, yet another drill guide 1800 includes ahandle 1802, a shaft 1804, and a working portion 1806. The shaft 1804 isbent, or zig-zag, in this example. Drill guide 1800 includes thefollowing features, which may be substantially similar to, or the sameas, the corresponding features of drill guide 1400: body 1808, firstsurface 1810, bone-facing surface 1812, hole 1814, hole 1816, hole 1818,protrusion 1820, and aperture 1830. Drill guide 1800 also includesprotrusion 1822, protrusion 1824, and pegs 1844, 1846, 1848. Peg 1844and hole 1814 are adjacent. In this example, protrusion 1820 extendsfrom the first surface 1810 around the hole 1814. Peg 1846 and hole 1816are adjacent. Protrusion 1822 extends from the first surface 1810 aroundthe hole 1816. Peg 1848 and hole 1818 are adjacent. Protrusion 1824extends from the first surface 1810 around the hole 1818. Drill guide1800 lacks a central hole or a spike.

Drill guide 1800 is shown with a drill 1890 in hole 1816. The drill 1890is interchangeably received in holes 1814, 1816, 1818. The drill 1890forms a hole sized to receive a portion of a triangular reinforcementplate, and may be identical to drill 1790. In one example, the drill1890 may form a 4.5 mm hole.

In addition to the matched-design cutting jig described above, the dowelopening may be further prepared and expanded with punches or broaches.This preparation step may be useful when the dowel shape is other thancircular, such as a dovetail design, although a punch or broach may alsobe used when the dowel shape is circular.

Referring to FIGS. 27A-27I, a punch 1900 includes a handle 1902, a shaft1904, and a working portion 1906. The handle 1902 and the workingportion 1906 are arranged at opposite ends of the shaft 1904, which isstraight in this example. The working portion 1906 includes a body 1908with a first surface 1910 and an opposite bone-facing surface 1912. Thebone-facing surface 1912 may match the bone-facing surface 106, 206,306, 406, 506, 706 of one of the glenoid components. The body 1908 isoriented at an obtuse angle relative to the shaft 1904. The obtuse angleis greater than ninety degrees and less than one hundred eighty degrees.The working portion 1906 includes at least one anchoring element 1914which protrudes outwardly from the bone-facing surface. The exampleshown includes anchoring elements 1914, 1916, 1918. Each anchoringelement includes a dowel 1920 and a triangular reinforcement plate 1922,as described above for the glenoid components. The body 1908 mayresemble one of the previously-described glenoid components, asillustrated in FIGS. 27A-27I. Alternatively, the body 1908 may includeonly enough material to form or surround the surfaces, hole(s), and/orprotrusion described above.

One example of the punch 1900 may be used as a cement tamp orpressurizer to push bone cement into bony interstices. Another exampleof the punch 1900 may include bone removal features 1924, which may beteeth, serrations, ridges and grooves, knurling, a sandpaper texture, orthe like, so that the punch 1900 may be used to form a complementarysocket to receive a glenoid component.

Referring to FIGS. 28A-28C, a broach 2000 includes a handle 2002, ashaft 2004, and a working portion 2006. The handle 2002 and the workingportion 2006 are arranged at opposite ends of the shaft 2004, which isstraight in this example. The working portion 2006 includes a body 2008with a first surface 2010 and an opposite bone-facing surface 2012. Thebone-facing surface 2012 may match the bone-facing surface 106, 206,306, 406, 506, 706 of one of the glenoid components. The body 2008 isoriented at an obtuse angle relative to the shaft 2004. The obtuse angleis greater than ninety degrees and less than one hundred eighty degrees.The working portion 2006 includes at least one anchoring element 2014which protrudes outwardly from the bone-facing surface. The exampleshown includes anchoring elements 2014, 2016, 2018. Each anchoringelement includes a dowel 2020 and a triangular reinforcement plate 2022,as described above for the glenoid components. The dowel 2020 and/orreinforcement plate 2022 may include bone removal features 1924, whichmay be teeth, serrations, ridges and grooves, knurling, a sandpapertexture, or the like, so that the broach 2000 may be used to form acomplementary bone socket to receive a glenoid component. In the exampleshown, the bone removal features 1924 are on the reinforcement plates2022, and include alternating ridges or teeth 1926 and grooves 1928. Thebody 2008 may include at least one aperture to provide a visualizationwindow for the user to judge when the bone-facing surface makes contactwith bone; the example shows two apertures 1930, 1932. The body 2008 mayresemble one of the previously-described glenoid components, asillustrated in FIGS. 28A-28C. Alternatively, the body 2008 may includeonly enough material to form or surround the surfaces, hole(s), and/orprotrusion described above.

Referring now to FIGS. 29-41, methods of using the instruments toprepare an implantation site for the glenoid components will now bedescribed. One of skill in the art will appreciate that there are manymethods for preparing a glenoid to receive the disclosed glenoidcomponents, and that the methods shown below represent a few examples ofthe methods available. Other methods contemplated may include the use ofa saw, such as a reciprocating or oscillating saw; a burr, which may bemotorized; a punch; an osteotome; and/or a curette, used alone or incombination with one or more drills, guides, and/or cutting jigs. Thesetools may be used to prepare the glenoid to receive one or more dowelsand/or reinforcement plates. Furthermore, while the illustrated methodand corresponding instruments include three anchoring elements, in otherexamples of the technology, the method and corresponding instrumentsinclude one or more anchoring elements corresponding to the number andlocation of the anchoring elements that are present on the selectedglenoid prosthetic component.

FIG. 29 illustrates a normal intact right shoulder joint including ascapula 2 and a humerus 20. The scapula includes a glenoid fossa 4, acoracoid process 6, and an acromion process 8.

FIG. 30 illustrates the step of inserting the sizing template 1200between the humeral head and the glenoid fossa 2. A drill, Beath pin, orK-wire may be inserted through the central hole 1216 to form a pilothole 10 in the glenoid fossa, as can be seen in FIG. 31. A small drillor reamer (not shown) may be used freehand at this point to expand thepilot hole 10.

FIG. 32 illustrates the step of reaming the glenoid fossa. The reamer1300 may be insinuated between the humeral head and the glenoid fossa 2by first engaging the drill tip 1332 in the pilot hole 10 with one ofthe indentations 1318, 1320 cradling the humeral head. The reamer shaft1304 may be inclined at an acute angle with respect to the glenoid fossaat this point. With the drill tip 1332 in the pilot hole, there issufficient leverage to push the humeral head posteriorly with the reamer1300. The reamer shaft 1304 may end up perpendicular to the glenoidfossa at this point. Once the reamer shaft 1304 is properly aligned withthe glenoid fossa 4 and the scapula 2, the reamer 1300 may be spun toprepare a reamed surface 14 in the glenoid fossa 4. At the same time,the drill tip 1332 and drill feature 1334, if present, prepare hole 12in the former location of the pilot hole 10. FIG. 33 shows the scapula 2after the reaming step.

FIGS. 34A-34C illustrate the step of drilling dowel holes. The drillguide 1500 is inserted between the humeral head and the glenoid fossa 4so that the central peg 1526 is received in hole 12. The drill guide1500 is then rotated about the central peg 1526 until the body 1508 isrotationally aligned as desired with the glenoid fossa 4. The drillguide 1500 is manually stabilized while drill 1590 is actuated throughone of the holes 1514, 1516, 1518, for example, hole 1516, thus creatingdowel hole 18 in the glenoid fossa 4. The drill 1590 is removed, and thekeel position tamp 1580 is inserted through holes 1516, 18 torotationally stabilize the drill guide 1500. Drill 1590 is then actuatedthrough the remaining two holes 1514, 1518 to create dowel holes 16, 22,respectively. FIG. 35 shows the scapula 2 after the first drilling step.The drill guide 1400 may be substituted for the drill guide 1500 in thisstep by using a peg or screw in central hole 1426 and hole 12.

FIG. 36 illustrates the step of drilling a first and second set of plateholes. The drill guide 1700 is inserted between the humeral head and theglenoid fossa 4 so that the pegs 1744, 1746, 1748 are received in holes16, 18, 22, respectively. The drill 1790 is actuated through each one ofholes 1714, 1716, 1718, 1732, 1734, 1736 to form plate holes 24, 26, 28,30, 32, 34, respectively. FIG. 37 shows the scapula 2 after the seconddrilling step.

FIG. 38 illustrates the step of drilling a third set of plate holes. Thedrill guide 1800 is inserted between the humeral head and the glenoidfossa 4 so that the pegs 1844, 1846, 1848 are received in holes 16, 18,22, respectively. The drill 1890 is actuated through each one of holes1814, 1816, 1818 to form plate holes 36, 38, 40, respectively. FIG. 39shows the scapula 2 after the third drilling step.

Instead of performing the steps illustrated in FIGS. 36-39, all threesets of plate holes may be drilled in a single step using the drillguide 1600 and a suitably sized drill.

FIG. 40A-40C illustrate the step of broaching a bone socket to receive aglenoid component. This step may be a fine-tuning step if performedafter the steps illustrated in FIGS. 29-39; this step may optionally beperformed instead of some or all of the steps illustrated in FIGS.29-39. The broach 2000 is inserted between the humeral head and theglenoid fossa 4 so that the anchoring elements 2014, 2016, 2018 arereceived in the prepared bone holes, with the dowels 2020 in the dowelholes 16, 18, 22 and the plates 2022 in the overlapping plate holes. Thebroach 2000 may be tapped into full engagement with the glenoid fossa 2while monitoring progress through the apertures 1930, 1932. In anothertechnique, the broach 2000 may be reciprocally advanced and withdrawn.The broach 2000 forms a bone socket (not shown) which is complementaryto the glenoid component. The bone socket may be larger all over thanthe glenoid component in order to provide clearance for an even mantleof bone cement around the anchoring elements of the glenoid component.The punch 1900 may be used instead of the broach 2000 in this step. Thepunch 1900 may also be used after the broach, and after the introductionof freshly mixed bone cement into the bone socket, to press the bonecement into the bony interstices before the final step, insertion of theprosthetic glenoid component. FIG. 41 illustrates the scapula 2 afterimplantation of a glenoid component 700.

The components disclosed herein may be fabricated from metals, alloys,polymers, plastics, ceramics, glasses, composite materials, orcombinations thereof, including but not limited to: PEEK, titanium,titanium alloys, commercially pure titanium grade 2, ASTM F67, Nitinol,cobalt chrome, stainless steel, ultra high molecular weight polyethylene(UHMWPE), biocompatible materials, and biodegradable materials, amongothers. Different materials may be used for different parts. Coatingsmay be present. Different materials may be used within a single part.Any component disclosed herein may be colored, coded or otherwise markedto make it easier for a user to identify the type and size of thecomponent, the setting, the function(s) of the component, and the like.

It should be understood that the present systems, kits, apparatuses, andmethods are not intended to be limited to the particular formsdisclosed. Rather, they are to cover all combinations, modifications,equivalents, and alternatives falling within the scope of the claims.

The claims are not to be interpreted as including means-plus- orstep-plus-function limitations, unless such a limitation is explicitlyrecited in a given claim using the phrase(s) “means for” or “step for,”respectively.

The term “coupled” is defined as connected, although not necessarilydirectly, and not necessarily mechanically.

The use of the word “a” or “an” when used in conjunction with the term“comprising” in the claims and/or the specification may mean “one,” butit is also consistent with the meaning of one or more or at least one.The term “about” means, in general, the stated value plus or minus 5%.The use of the term “or” in the claims is used to mean “and/or” unlessexplicitly indicated to refer to alternatives only or the alternativeare mutually exclusive, although the disclosure supports a definitionthat refers to only alternatives and “and/or.”

The terms “comprise” (and any form of comprise, such as “comprises” and“comprising”), “have” (and any form of have, such as “has” and“having”), “include” (and any form of include, such as “includes” and“including”) and “contain” (and any form of contain, such as “contains”and “containing”) are open-ended linking verbs. As a result, a method ordevice that “comprises,” “has,” “includes” or “contains” one or moresteps or elements, possesses those one or more steps or elements, but isnot limited to possessing only those one or more elements. Likewise, astep of a method or an element of a device that “comprises,” “has,”“includes” or “contains” one or more features, possesses those one ormore features, but is not limited to possessing only those one or morefeatures. Furthermore, a device or structure that is configured in acertain way is configured in at least that way, but may also beconfigured in ways that are not listed.

In the foregoing Detailed Description, various features are groupedtogether in several examples for the purpose of streamlining thedisclosure. This method of disclosure is not to be interpreted asreflecting an intention that the examples of the invention require morefeatures than are expressly recited in each claim. Rather, as thefollowing claims reflect, inventive subject matter lies in less than allfeatures of a single disclosed example. Thus, the following claims arehereby incorporated into the Detailed Description, with each claimstanding on its own as a separate example.

1. An arthroplasty system comprising: an arthroplasty implant comprisinga body, a peg, and a keel; wherein the body comprises a length, a width,a thickness, a joint-facing side, and a bone-facing side, wherein thelength, the width, and the thickness are mutually orthogonal, whereinthe length is greater than the width, wherein the width is greater thanthe thickness, wherein the bone-facing side is opposite the joint-facingside, wherein the thickness extends between the joint-facing side andthe bone-facing side, wherein the peg extends from the bone-facing sideobliquely away from the body across the width, wherein the keel extendsfrom the bone-facing side away from the body, wherein the keel extendsacross the width.
 2. The arthroplasty system of claim 1, wherein thebody comprises a front side and a back side opposite the front side,wherein the front and back sides each extend across the length and thethickness, wherein the bone-facing side extends across the length andthe width, wherein the peg extends toward the back side.
 3. Thearthroplasty system of claim 2, wherein the peg originates from thebone-facing side near the front side.
 4. The arthroplasty system ofclaim 1, wherein the peg is enlarged where the peg joins the bone-facingside.
 5. The arthroplasty system of claim 1, wherein the keel extendsfrom the bone-facing side toward the peg.
 6. The arthroplasty system ofclaim 5, wherein the keel intersects the peg.
 7. The arthroplasty systemof claim 1, wherein the keel is enlarged where the keel joins thebone-facing side.
 8. An arthroplasty system comprising: an arthroplastyimplant comprising a body, a peg, and a reinforcement; wherein the bodycomprises a joint-facing side and a bone-facing side opposite thejoint-facing side, wherein the bone-facing side extends along a lengthdimension of the body and a width dimension of the body, wherein thewidth dimension is perpendicular to the length dimension; wherein thepeg extends from the bone-facing side obliquely away from the bodyacross the width dimension; wherein the reinforcement extends from thebone-facing side away from the body, wherein the reinforcement extendsacross the width dimension.
 9. The arthroplasty system of claim 8,wherein the body comprises a front side and a back side opposite thefront side, wherein the front and back sides each extend along thelength dimension between the joint-facing side and the bone-facing side,wherein the peg extends toward the back side.
 10. The arthroplastysystem of claim 9, wherein the peg originates from the bone-facing sidenear the front side.
 11. The arthroplasty system of claim 8, wherein thepeg is enlarged where the peg joins the bone-facing side.
 12. Thearthroplasty system of claim 8, wherein the keel extends from thebone-facing side toward the peg.
 13. The arthroplasty system of claim12, wherein the keel intersects the peg.
 14. The arthroplasty system ofclaim 8, wherein the keel is enlarged where the keel joins thebone-facing side.
 15. An arthroplasty system comprising: a glenoidimplant adapted for an antero-lateral surgical trajectory to a glenoidof a scapula, the glenoid implant comprising a body, a peg, and a keel;wherein the body comprises a glenoid-facing medial side, ahumerus-facing lateral side, an anterior side, and a posterior side;wherein the peg extends outwardly from the medial side along thetrajectory toward the posterior side; wherein the keel comprises alength, a width, and a thickness, wherein the length, the width, and thethickness are mutually orthogonal, wherein the length is greater thanthe thickness, wherein the width is greater than the thickness, whereinthe length extends outwardly from the medial side, wherein the widthextends across at least a portion of the medial side between theanterior and posterior sides.
 16. The arthroplasty system of claim 15,wherein the peg originates from the medial side near the anterior side.17. The arthroplasty system of claim 15, wherein the peg or the keel isenlarged at the medial side.
 18. The arthroplasty system of claim 15,wherein the keel extends from the medial side toward the peg.
 19. Thearthroplasty system of claim 18, wherein the keel intersects the peg.